Provider Demographics
NPI:1982603890
Name:OHEMENG, AUGUSTUS K (MD)
Entity type:Individual
Prefix:
First Name:AUGUSTUS
Middle Name:K
Last Name:OHEMENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 E. SOUTH ST.
Mailing Address - Street 2:STE 303
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712
Mailing Address - Country:US
Mailing Address - Phone:714-995-5751
Mailing Address - Fax:
Practice Address - Street 1:3650 E. SOUTH ST.
Practice Address - Street 2:STE 303
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712
Practice Address - Country:US
Practice Address - Phone:562-923-4911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48589207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A485890OtherMEDI CAL
CA00A485890OtherMEDI CAL